Cert moulage feb 2014

Introduction to Moulage for

Fairfax County CERT

Susy Ledgerwood Volunteer Instructor/CERT 4

2008 2008

Course Preview

● Introduction to Moulage Introduction

Basic Supplies

Working with Actors

General Guidance

● Representative Injuries

● Moulage Technique Scrapes

Bruises

Lacerations

Open Fractures

Burns

● Summary Summary

Introduction to Moulage

for Fairfax County CERT 1

Impalements

Cyanosis / Shock

Pre-made Wounds

Cleanup

Additional Resources

2008 2008

Course Objectives

● Understand the purpose of moulage

● Become familiar with moulage supplies

● Learn how to work with actors

● Review types of injuries appropriate to CERT exercises

● Learn and practice basic techniques for creating

“injuries”




Fairfax County CERT

Introduction

2008 2008

Introduction

● Moulage – French for “casting” or “molding”

The art of creating/using 3-dimensional replicas of injuries,

diseases, and symptoms for training medical, emergency

response, and military personnel

● Use of moulage in CERT

Increases realism in training exercises and practical exams

Gives actors an injury to act out

Gives rescuers something to triage and treat

Creates a more realistic stress level

Key challenges of CERT moulage

Lots of victims to moulage in very limited time

Limited “real estate” to work with



2008 2008

Basic Supplies

● Materials

Creme-based makeups Color wheels (bruise, burn, trauma)

Foundations (normal flesh tones and shock)

Alcohol activated makeups/color palettes (requires 99% alcohol to activate)

Waxes (scar, bone) and gelatins

Blood (thick, gel, stage, “soaped”, powdered)

Latex

Adhesives (e.g., spirit gum) and removers

Petroleum jelly/lubricant

Glycerin (diluted 50% with water)

Powders (translucent, charcoal, ash, dirt)

Cotton balls

Styrofoam peanuts/modeling clay

Impalements (“glass” shards, wood, metal, etc.)

Duct tape and/or medical tape

● Tools

Cosmetic sponges

Stipple sponges

Powder puffs

Brushes (blush, paint)

Sculpting tools/spatulas

Scissors

Towels and paper towels

Baby and alcohol wipes

Cotton swabs

Small containers/cups

Trash bags

Gloves

Mirror



Use your imagination!

2008 2008

Working with Actors

● Talk to the actors Let them know what you are doing as you are doing it

Most men are not used to having makeup applied to their faces!

Check for allergies/sensitivities (e.g., latex)

Can you dirty or tear their clothing?

Tell them how to act out their injury and encourage them to do so

Tell them cool water should get blood out (but no guarantees)

Let them see the result

Thank them for their time

● Avoid latex and waxes in hairy areas!

● Hygiene Use clean sponges or hands to avoid transferring germs from one

actor to another

Avoid contaminating supplies with dirty fingers or sponges Place small amount on palette or hand and use from there instead



2008 2008

General Guidance

● Less is more

You are trying to simulate realistic injuries, not create

Halloween costumes

● Need to work quickly and confidently

We often have less than an hour to make up 50-100 victims

● Know your triage colors

You may need to assign injuries that match the actors’ colors

● Think about how the actor will be placed

Blood should drip in direction of ground when placed (not

necessarily the same as when seated in a chair)

Try to keep the actor comfortable




Fairfax County CERT

Representative Injuries

2008 2008

● Red

Symptoms

Unconscious/semi-conscious/confused (acting)

Rapid, shallow breathing (acting)

Severe bleeding

Shock

Moulage

Pale/sweaty/cyanotic for shock

Severe burns

Severe bleeding

Head injuries

Impalements and amputations (with severe bleeding)




2008 2008

● Yellow

Symptoms

Trapped or can’t walk

Leg injuries – breaks, sprains, and strains

Moulage

Open fractures

Bruising to indicate a sprain or closed fracture

Swelling (wadded up duct tape, padding, or paper towel under

clothing works)

Mostly acting and victim placement

Trapped

Legs at awkward angles (but only as rescuers approach to prevent

actor discomfort)

Actor screams in pain when “injured” leg or foot is touched and

pretends he/she can’t walk on it




2008 2008

● Green

Symptoms

“Walking Wounded”

Arm injuries

Minor boo-boos

Victims may be annoying or helpful

Moulage

Scrapes

Bruises

Minor lacerations

Minor burns

Broken arms, sprained wrists

“Dirtied up”





Fairfax County CERT

Moulage Technique

2008 2008

Scrapes

● Redden skin with bruise

wheel and set with

translucent powder

● Create scrapes using

stipple sponge and blood

or red foundation from

color wheel

Lightly drag sponge across

skin to create scrape

Can add additional few

drops of blood if desired



2008 2008

Bruises - Materials

● Use bruise wheel or

alcohol activated

makeup for coloring

● Apply coloring with

Fingers

Cosmetic sponges

Stipple sponges

● Set with translucent

powder using cosmetic

puff/brush



2008 2008

Bruises - Technique

● New bruises - apply red

as a base, then add

burgundy and purples

Use stipple or torn

cosmetic sponge to add

blotches around edges –

avoid even coloring

For darker skin tones, use

more midnight blue and

less red

Set with translucent

powder



2008 2008

Bruises – Technique (Cont’d)

● Old bruises – blend in

green and/or yellow to

age the bruise, but don’t

overdo it

We won’t do many aged

bruises – the disaster just

happened!



2008 2008

Bruises – Technique (Cont’d)

● Add dimensionality by

Accentuating shadows

around bones with

burgundy, purple, or

midnight blue

Highlighting bones with

yellow (e.g., cheekbones,

brows, wrists)

● Think about shapes of

bruises – they should

match the cause of the

bruise



2008 2008

Scrapes and Bruises

● Hands on Exercise:

Work in pairs to create scrapes and

bruises on each other



2008 2008

● Scar/modeling wax or gelatin

● Spirit gum and cotton balls (optional)

● Spirit gum remover, baby oil, or coconut oil

● Color wheels or palettes

● Foundation colors

● Setting powder

● Blood – thick, gel, stage

● Stipple sponge

● Brushes, puffs, and cosmetic sponges

Lacerations - Materials



2008 2008

Lacerations – Technique

● Apply to clean skin

Wax adheres better on firm/bony

areas than fleshy areas

● Can use spirit gum and cotton ball for

better adhesion

Apply spirit gum to skin and tap with

finger until it gets tacky

Dab spirit gum with cotton ball to give

wax something to adhere to

DON’T use spirit gum on hairy areas!

● Create a “snake roll” of wax and apply

to skin (or spirit gum and cotton);

press wax to adhere firmly



2008 2008

Lacerations – Technique (Cont’d)

● Using finger or modeling tool,

smear edges of wax out,

leaving a center ridge

● Use baby oil or spirit gum

remover to smooth out wax

and blend it into skin

● Use a stipple sponge or torn

cosmetic sponge to create

“pores” and remove

smoothness in the wax



2008 2008


● Lightly apply skin color

foundation with sponge and

blend into skin

● Use colors from bruise

wheel to lightly bruise up

laceration site

● Apply setting powder



2008 2008


● Use sculpting tool to create

laceration in wax

● Paint coral color from burn

wheel into inside edges of

wound

● Paint purple or dark blue

color into center of

laceration to provide depth



2008 2008


● Apply blood

Use thick blood for clotted

areas

“Soap” stage blood with a

few drops of baby

shampoo or dishwashing

liquid for better adhesion

over waxes and makeup

(avoid eyes and mouth!)

Think about direction of

drip



2008 2008

Lacerations – Alternate Technique

● Can also use gelatin to create wounds

Heat bottle in very hot water to melt/liquefy

the gelatin

Test temperature before applying to skin to

avoid burns!

Apply directly to skin and sculpt as it cools

to create the wound, or use molds to create

prosthetic appliances that can be applied

with spirit gum

Color and apply blood

Keep gelatin in bowl of hot water to keep it

liquefied while working

Powder gelatin prosthetics to keep them

from sticking to themselves


for Fairfax County CERT

25

2008 2008

Open Fractures

● Same general technique

as laceration but create a

jagged hole for the bone

● Insert small “bone” into

the hole

Packing peanuts

Cotton padding

Plastic tubing

Modeling clay

Be creative!



2008 2008

Lacerations


Work in pairs to create lacerations

on each other



2008 2008

Burns – Materials

● Burn color wheel

● Paint brushes

● Cosmetic sponges

● Stipple sponges

● Petroleum Jelly

(e.g., Vaseline)

● Lubricant

● Tissues

● Latex

● Charcoal and ash powders



2008 2008

Burns - Technique

● Superficial (1st degree)

Redden area using colors

on burn wheel

Be sure to get in all

creases in skin

Blend well to edges of burn



2008 2008

Burns – Technique (Cont’d)

● Partial Thickness (2nd degree)

Start with red as a base color

Mottle with purple and salmon,

especially around blood vessels

Create blisters using blobs of

petroleum jelly

Cover with a single ply of tissue

torn with ragged edges and

saturate with lubricant to adhere,

or

Cover with latex

Can burst a few of the blisters



2008 2008

Burns – Technique (Cont’d)

● Full Thickness (3rd degree)

Same general approach as

partial thickness burn, but:

Darken centers and highlight

sides of major blood vessels

Apply black cream foundation

and/or charcoal as charring,

pushing up edges of

tissue/latex as you do to

slough up the burned skin

Can also “burn” clothing, add

smoke inhalation marks to

nose/mouth using charcoal

Can add “liquid smoke” to

simulate burning smell



2008 2008

Burns – Alternate Technique

● Can also create burns using latex Apply color (and petroleum jelly

blisters if desired)

Apply thin layer of latex with torn cosmetic sponge

After latex has dried, pull up in places to create blisters

Apply additional color or charcoal as desired



Remember to check for latex

allergies before using this technique!

2008 2008

Burns – Alternate Techniques

● Can also create burns using:

TraumaSkin FX™ DermaBurn

Plastic wrap type material that can be activated and sculpted to

create burns

Lay down base colors first; apply DermaBurn; spray lightly with

water, sculpt, add blood powder, charcoal, and/or ash powder to

finish

Gelatin

Heat container of gelatin in hot water until liquefied

(be sure to test temperature before applying on actor)

Lay down base colors first; apply gelatin; allow to cool until it can be

sculpted, add blood powder, charcoal, and/or ash powder to finish



2008 2008

Burns


Work in pairs to create burns

on each other



2008 2008

Impalements

● Insert small impalements

(e.g., “glass”) in a laceration

Can create “glass” shards by heating

pieces of #6 plastic in a 350 oven for a

few minutes (“shrinky dink”)

● Affix larger impalements to a

cardboard base with duct tape

Hide in pocket, waistband, or hole in

clothing

Add plenty of blood!



Be aware of actor and rescuer

safety – avoid sharp ends/edges

2008 2008

Cyanosis / Shock

● Use creme makeup to make actor pale

Cover all areas (face, eyelids, ears, hands, etc.) and

blend very well – victim should be pale, not white

Use Cyanotic Blue, Corpse Flesh, Blythe Spirit, or Frankie

Gray, or a very thin application of clown white makeup

May mix with flesh tone foundation for better coloring

Use purple or dark blue from bruise wheel to darken

eye sockets, temples, under cheekbones, sunken

parts of neck, lips, earlobes, nail beds (wherever

there isn’t bone)

Can put a narrow line of red under eyes with brush

Can add thick blood for bleeding from ears or nose

Can spray 50% glycerin/water for “perspiration”



2008 2008

Using Pre-made Wounds

● Strap-on wounds Reusable

Good for “quick and dirty”

moulage

Apply blood as needed

Be sure to get wounds

back after use!

● Latex, silicone, or gelatin

wounds May or may not be reusable

Apply with spirit gum

Apply latex at edges to blend

into skin (use torn sponge)

Blend in with foundation

Add blood and coloring as

needed



2008 2008

Cleanup

● Keep trash bags handy and use them as you go!

● Cover tables with plastic bags or sheeting for easy cleanup

● Have makeup removal supplies available for actors

Cream makeups – use makeup remover, soap and water, and/or

baby wipes

Blood – use soap and water

Wax – remove majority with dental floss, then rest with makeup

remover, coconut oil, and/or soap and water

Spirit gum or adhesives – use spirit gum remover or other adhesive

removers

● Clean brushes, stipple sponges, tools, and makeup

containers before long term storage

Introduction to Moulage for CERT 38


Fairfax County CERT

Summary

2008 2008

Summary

● Use moulage to add realism to exercises

● Need to balance detail vs. time

● Acting complements moulage – don’t forget to coach

your actors!

● Practice makes perfect - As the “final exam” for this

course, students are encouraged to assist with moulage

at a future CERT Final Exercise (next one is 3/22/14)

● Other potential moulage opportunities

Capital Shield exercise (October 2014)

CERTCon exercise

EMT practical exams

Firefighter classes



2008 2008

Additional Resources

● Search online images for pictures of real-world and moulaged injuries

● Websites with additional moulage tips, techniques, and recipes:

http://www.fairfaxcert.com/userresources.php

http://www.cert-la.com/education/moulage.htm

http://www.vdh.state.va.us/OEMS/Training/ResourceCD/Moulage.htm

http://casualtysim.webs.com/casualty_simulation_techniques.pdf

http://www.inquiry.net/outdoor/skills/instruction/simulations.htm

http://ebookbrowse.com/step-by-step-moulage-ppt-d144532915

http://www.whatcomcountyems.com/pdfs/CE%20Instructors/ BASIC%20MOULAGE.pdf

Don’t forget to check Google and YouTube!

● Supplies

Halloween and party stores

http://www.fxwarehouse.info

https://www.paintandpowderstore.com

http://www.ptsonline.biz/

And many more!



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Cert moulage feb 2014